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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In December 2019 a series of cases were reported&#44; describing patients admitted to hospital with a new disease characterized by pneumonia and respiratory failure caused by a novel coronavirus &#40;SARS-CoV-2&#41;&#44; in the province of Hubei &#40;China&#41;&#46; On 11 February 2020&#44; the World Health Organization &#40;WHO&#41; termed this etiological agent as COVID-19 &#40;Coronavirus Disease&#44; 2019&#41;&#46; Posteriorly&#44; and despite the adoption of extensive containment measures&#44; the disease continued to spread&#44; affecting the rest of Asian countries&#44; the Middle East and Europe&#46; On 11 March&#44; COVID-19 was declared a pandemic at a world press conference held by Tedros Adhanom Ghebreyesus&#44; General Director of the WHO&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first official case of COVID-19 in Spain was recorded on 31 January 2020&#46; It corresponded to a mild and imported infection in a German patient admitted to hospital on the island of La Gomera &#40;Canary Islands&#41;&#46; Nine days later a new and likewise imported case was detected in Palma de Mallorca &#40;Balearic Islands&#41;&#46; The first cases on the Spanish mainland were identified on 24 February&#44; followed by exponential expansion of the virus&#44; affecting mainly the Community of Madrid&#44; the Basque Country and Catalonia&#46; According to the latest information from the Spanish Ministry of Health&#44; on 5 April 2020 there were 135&#44;032 confirmed cases in Spain&#44; with 59&#44;662 patients in hospital&#44; 6931 in intensive care&#44; and 13&#44;055 deaths associated to COVID-19 infection&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Most of the cases were concentrated in the Community of Madrid&#44; with 38&#44;723 confirmed cases&#44; and in Catalonia&#44; with 26&#44;824 confirmed cases&#46; However&#44; a recent study by the Imperial College &#40;London&#41; estimated the actual number of infected individuals in Spain to be 7 million&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The state of alarm&#44; with confinement of the population&#44; was declared on 14 March&#46; As a consequence&#44; there has been a gradual decrease in the basic reproductive number of the pathogen &#40;R0&#41;&#44; which is the average number of secondary COVID-19 cases caused by a single primary case&#44; from &#62; 2&#46;0 to 0&#46;98 on 4 April&#46; In turn&#44; the contagion rate has been reduced from 40&#37; &#40;prior to confinement&#41; to 3&#46;2&#37; on 6 April&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The Spanish Society of Intensive and Critical Care Medicine and Coronary Units &#40;Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#91;SEMICYUC&#93;&#41; has adopted a series of measures with the purpose of reducing the impact of the pandemic upon the Spanish Intensive Care Units &#40;ICUs&#41; and healthcare system&#46; The Contingency Plan for the Departments of Intensive Care Medicine<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> has been very useful in allowing the ICUs to know the increase in healthcare burden they would have to face and how to adjust to the situation in a planned and organized manner&#46; &#8220;Hope for the best but prepare for the worst&#8221; has been the guiding principle in many Spanish ICUs&#46; The ethical recommendations on decision making in such exceptional circumstances have been the basis of the protocols in most hospitals&#46; Likewise&#44; the SEMICYUC has developed a series of recommendations&#44; both of its own and in combination with other scientific societies&#44; for the management of COVID-19 pneumonia in the critically ill &#8211; including airway management&#44; noninvasive mechanical ventilation&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> sedoanalgesia and inter-hospital patient transfer&#44; among other aspects&#46; All this material is available in a specific section of the SEMICYUC website&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The Steering Committee of the SEMICYUC has remained in contact through weekly teleconferences with the Heads of Department to directly know the situation in each ICU in the country&#44; and to share information&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The management of critical patients with COVID-19 pneumonia during the pandemic has been the greatest challenge faced by Intensive Care Medicine in all its history&#46; Intensivists&#44; in collaboration with many other professionals&#44; have habilitated up to 300&#37; more critical patient beds in hospitals &#8211; this representing an unprecedented care and logistic challenge&#46; However&#44; there have also been many other difficulties&#46; The evidence on the management of COVID-19 pneumonia is very limited&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> since this is a new disease&#44; requiring permanent updating of the care protocols&#46; Likewise&#44; the worldwide increase in the consumption of many drugs commonly used in Intensive Care Medicine&#44; such as those used for sedoanalgesia&#44; has made it necessary to resort to other less optimum alternatives&#46; The assignment of resources in situations of scarcity<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> has resulted in moral distress added to the existing work overload&#46; Although personal protection equipment &#40;PPE&#41; is essential for the safety of the healthcare staff&#44; the huge demand for such equipment has made it necessary to greatly rationalize its use&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It should be underscored that an important percentage of the healthcare professionals in Spain &#40;about 14&#37;&#41; have become infected with COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> On the other hand&#44; the acquisition of medical equipment &#8211; fundamentally respirators &#8211; has been very limited due to the great worldwide demand and the scarce local production of such equipment&#46; It has been necessary to resort to old equipment&#44; together with operating room respirators&#44; patient transfer respirators&#44; adaptations of noninvasive ventilation devices&#44; and even &#40;anecdotally&#41; to mechanized bag valve masks &#40;Ambu bags&#41;&#46; At present we are still concerned about different situations&#44; in view of the current saturation of the ICUs&#46; The end of population confinement may give rise to an increase in the number of cases&#44; and although serious diseases other than COVID-10 infection have temporarily decreased&#44; it will be necessary to deal with them again&#44; and our capacity to face new catastrophes is at least temporarily practically zero&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In sum&#44; Spanish intensivists have shown that despite the adverse circumstances&#44; they have been able to organize&#44; collaborate with other specialists and adapt with resilience to manage all critical patients with COVID-19 pneumonia&#46; We must prepare ourselves to bring the hospitals back to normal once again&#46; The process will be neither easy nor rapid&#44; but should contemplate the need to secure enough equipment to deal with other catastrophes in future&#46;</p></span>"
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Editorial
COVID-19 Pandemic: the greatest challenge in the history of critical care
Pandemia por COVID-19: el mayor reto de la historia del intensivismo
R. Ferrera,b,c
a Shock, Organ Dysfunction, and Resuscitation Research Group (SODIR), Instituto de Investigación de Vall d’Hebron, Barcelona, Spain
b Departamento de Medicina Intensiva, Hospital Universitario de Vall d'Hebron, Barcelona, Spain
c Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In December 2019 a series of cases were reported&#44; describing patients admitted to hospital with a new disease characterized by pneumonia and respiratory failure caused by a novel coronavirus &#40;SARS-CoV-2&#41;&#44; in the province of Hubei &#40;China&#41;&#46; On 11 February 2020&#44; the World Health Organization &#40;WHO&#41; termed this etiological agent as COVID-19 &#40;Coronavirus Disease&#44; 2019&#41;&#46; Posteriorly&#44; and despite the adoption of extensive containment measures&#44; the disease continued to spread&#44; affecting the rest of Asian countries&#44; the Middle East and Europe&#46; On 11 March&#44; COVID-19 was declared a pandemic at a world press conference held by Tedros Adhanom Ghebreyesus&#44; General Director of the WHO&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first official case of COVID-19 in Spain was recorded on 31 January 2020&#46; It corresponded to a mild and imported infection in a German patient admitted to hospital on the island of La Gomera &#40;Canary Islands&#41;&#46; Nine days later a new and likewise imported case was detected in Palma de Mallorca &#40;Balearic Islands&#41;&#46; The first cases on the Spanish mainland were identified on 24 February&#44; followed by exponential expansion of the virus&#44; affecting mainly the Community of Madrid&#44; the Basque Country and Catalonia&#46; According to the latest information from the Spanish Ministry of Health&#44; on 5 April 2020 there were 135&#44;032 confirmed cases in Spain&#44; with 59&#44;662 patients in hospital&#44; 6931 in intensive care&#44; and 13&#44;055 deaths associated to COVID-19 infection&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Most of the cases were concentrated in the Community of Madrid&#44; with 38&#44;723 confirmed cases&#44; and in Catalonia&#44; with 26&#44;824 confirmed cases&#46; However&#44; a recent study by the Imperial College &#40;London&#41; estimated the actual number of infected individuals in Spain to be 7 million&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The state of alarm&#44; with confinement of the population&#44; was declared on 14 March&#46; As a consequence&#44; there has been a gradual decrease in the basic reproductive number of the pathogen &#40;R0&#41;&#44; which is the average number of secondary COVID-19 cases caused by a single primary case&#44; from &#62; 2&#46;0 to 0&#46;98 on 4 April&#46; In turn&#44; the contagion rate has been reduced from 40&#37; &#40;prior to confinement&#41; to 3&#46;2&#37; on 6 April&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The Spanish Society of Intensive and Critical Care Medicine and Coronary Units &#40;Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#91;SEMICYUC&#93;&#41; has adopted a series of measures with the purpose of reducing the impact of the pandemic upon the Spanish Intensive Care Units &#40;ICUs&#41; and healthcare system&#46; The Contingency Plan for the Departments of Intensive Care Medicine<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> has been very useful in allowing the ICUs to know the increase in healthcare burden they would have to face and how to adjust to the situation in a planned and organized manner&#46; &#8220;Hope for the best but prepare for the worst&#8221; has been the guiding principle in many Spanish ICUs&#46; The ethical recommendations on decision making in such exceptional circumstances have been the basis of the protocols in most hospitals&#46; Likewise&#44; the SEMICYUC has developed a series of recommendations&#44; both of its own and in combination with other scientific societies&#44; for the management of COVID-19 pneumonia in the critically ill &#8211; including airway management&#44; noninvasive mechanical ventilation&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> sedoanalgesia and inter-hospital patient transfer&#44; among other aspects&#46; All this material is available in a specific section of the SEMICYUC website&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The Steering Committee of the SEMICYUC has remained in contact through weekly teleconferences with the Heads of Department to directly know the situation in each ICU in the country&#44; and to share information&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The management of critical patients with COVID-19 pneumonia during the pandemic has been the greatest challenge faced by Intensive Care Medicine in all its history&#46; Intensivists&#44; in collaboration with many other professionals&#44; have habilitated up to 300&#37; more critical patient beds in hospitals &#8211; this representing an unprecedented care and logistic challenge&#46; However&#44; there have also been many other difficulties&#46; The evidence on the management of COVID-19 pneumonia is very limited&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> since this is a new disease&#44; requiring permanent updating of the care protocols&#46; Likewise&#44; the worldwide increase in the consumption of many drugs commonly used in Intensive Care Medicine&#44; such as those used for sedoanalgesia&#44; has made it necessary to resort to other less optimum alternatives&#46; The assignment of resources in situations of scarcity<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> has resulted in moral distress added to the existing work overload&#46; Although personal protection equipment &#40;PPE&#41; is essential for the safety of the healthcare staff&#44; the huge demand for such equipment has made it necessary to greatly rationalize its use&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It should be underscored that an important percentage of the healthcare professionals in Spain &#40;about 14&#37;&#41; have become infected with COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> On the other hand&#44; the acquisition of medical equipment &#8211; fundamentally respirators &#8211; has been very limited due to the great worldwide demand and the scarce local production of such equipment&#46; It has been necessary to resort to old equipment&#44; together with operating room respirators&#44; patient transfer respirators&#44; adaptations of noninvasive ventilation devices&#44; and even &#40;anecdotally&#41; to mechanized bag valve masks &#40;Ambu bags&#41;&#46; At present we are still concerned about different situations&#44; in view of the current saturation of the ICUs&#46; The end of population confinement may give rise to an increase in the number of cases&#44; and although serious diseases other than COVID-10 infection have temporarily decreased&#44; it will be necessary to deal with them again&#44; and our capacity to face new catastrophes is at least temporarily practically zero&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In sum&#44; Spanish intensivists have shown that despite the adverse circumstances&#44; they have been able to organize&#44; collaborate with other specialists and adapt with resilience to manage all critical patients with COVID-19 pneumonia&#46; We must prepare ourselves to bring the hospitals back to normal once again&#46; The process will be neither easy nor rapid&#44; but should contemplate the need to secure enough equipment to deal with other catastrophes in future&#46;</p></span>"
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Article information
ISSN: 21735727
Original language: English
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